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Discharge prescription patterns in multiarterial versus single-arterial coronary artery bypass grafting: A regional
Emily C Scheffel1, Matthew P Weber2, Lauryn A Ridley1
1University of Virginia School of Medicine, Charlottesville, Va.
Insights
Patients undergoing multiarterial grafting (MAG) for coronary artery bypass grafting (CABG) receive dual antiplatelet therapy (DAPT) more often than those with single arterial grafting (SAG). These prescription patterns differ and impact outcome comparisons.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Pharmacotherapy in Cardiac Procedures
Background:
- Medical management post-coronary artery bypass grafting (CABG) varies based on arterial conduit selection.
- Characterizing discharge prescriptions after multiarterial grafting (MAG) versus single arterial grafting (SAG) is crucial for understanding patient care pathways.
Purpose of the Study:
- To investigate and compare discharge prescription patterns following CABG, specifically examining differences between MAG and SAG cohorts.
- To identify associations between conduit selection (MAG vs. SAG) and the prescription of key cardiovascular medications.
Main Methods:
- Retrospective analysis of 10,966 isolated CABG patients from a 17-institution collaborative (2020-2023).
- Stratification into MAG and SAG groups.
- Analysis of discharge prescriptions for dual antiplatelet therapy (DAPT), anticoagulation, beta-blockers, and ACE inhibitors/ARBs, using multivariable logistic regression.
Main Results:
- MAG patients (n=2062) were younger and had lower predicted mortality risk compared to SAG patients (n=8904).
- MAG patients were significantly more likely to receive DAPT (70.6% vs. 51.2%) and amiodarone, and less likely to receive anticoagulants or ACE inhibitors/ARBs.
- Multivariable analysis confirmed MAG independently associated with DAPT prescription (OR, 1.69; 95% CI, 1.4-2.0).
Conclusions:
- Multiarterial grafting (MAG) is independently associated with higher rates of dual antiplatelet therapy (DAPT) prescription at discharge.
- Significant differences exist in postrevascularization medication strategies between MAG and SAG patients.
- These disparities in medical management should be considered when comparing outcomes between MAG and SAG cohorts.
Objective:
Medical management after multiarterial grafting (MAG) versus single arterial grafting (SAG) in coronary artery bypass grafting (CABG) is less characterized. We sought to identify discharge prescription patterns after CABG on the basis of conduit selection.
Methods:
This retrospective study included patients from a 17-institution regional collaborative undergoing isolated CABG from 2020 to 2023. Patients were stratified into MAG and SAG cohorts. Primary analysis included dual antiplatelet therapy (DAPT), anticoagulation, beta-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker discharge prescription rates. Multivariable logistic regression was executed to assess independent associations.
Results:
The cohort included 10,966 patients (8904 SAG, 2062 MAG). Patients in the SAG group were significantly older with a median age of 67 years [61, 74] versus 61 years [55, 68] in the MAG cohort. Patients in the SAG group were more likely to present with non-ST-segment elevation myocardial infarction (34.1% vs 31.0%, P < .01) and greater Society of Thoracic Surgeons predicted risk of mortality (1.1% vs 0.7%, P < .01). Patients in the MAG group were more likely to be prescribed DAPT (51.2% vs 70.6%, P < .01), amiodarone (54.2% vs 66.7%, P < .01) and less likely to be prescribed any anticoagulants (12.7% vs 9.1%, P < .01), warfarin (3.2% vs 1.5%, P < .01) or angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (24.6% vs 19.8%, P < .01). After risk adjustment, MAG was independently associated with DAPT (odds ratio, 1.69 [1.4-2.0], P < .01).
Conclusions:
Patients undergoing MAG are more likely to be prescribed DAPT at discharge, independent of clinical presentation and baseline comorbidities. Differences in postrevascularization medications between patients who receive MAG and SAG differ and should be considered when comparing groups and outcomes.
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